摘要
目的 Nuss手术作为治疗漏斗胸的微创方法在临床上得到广泛应用,并不断改良发展。文中分析改良Nuss手术矫治漏斗胸的近、中期疗效,总结临床治疗经验。方法 2009年2月至2010年4月施行非胸腔镜辅助下的改良Nuss手术31例。26例为对称型漏斗胸患者,5例为不对称型。其中2例为传统Ravitch术后复发性漏斗胸。所有手术均在非胸腔镜辅助下完成。术中放置双弧形钢板和斜行钢板者各5例。术后1.8～2.5年取出固定钢板。结果 31例均顺利完成改良Nuss手术,无严重术中并发症,术后均获随访。术后近期矫形效果优28例,良3例。4例术后早期有少量气胸及皮下气肿,未予特殊处理,术后1月复查胸片均吸收消失;1例术后4月切口渗液感染,经换药等处理后愈合;1例术后半年钢板移位旋转,予以再次手术,双侧放置固定小钢板垫片,随访1.5年无钢板移位旋转。28例行内固定钢板取出,矫形效果24例优,4例良,无严重术中并发症,术后2～3d出院,随访无复发。结论非胸腔镜辅助下的改良Nuss手术是安全可行的,创伤小,再次钢板取出术也是安全易行的。手术近、中期疗效满意,远期效果等待进一步随访。
Objective The Nuss procedure, a minimally invasive surgery, has gained wide acceptance and steady improve- ment in the treatment of pectus excavatum. This study aims to analyze the short-and mid-term effects and summarize the clinical experi- ences of modified Nuss procedure for the correction of pectus excavatum. Methods Thirty-one patients with pectus excavatum were corrected by modified Nuss procedure without thoracoscopic assistance from February 2009 to April 2010, of which 26 were symmetri- cal, 5 asymmetrical, and 2 recurrent after Raviteh procedure. Double are steel bars were imported in 5 cases, and oblique ones in an- other 5. The bars were removed 1.8 to 2.5 years later. Results Modified Nuss procedure was accomplished in all the cases without severe postoperative complications, and all were followed up. Short-term evaluation showed excellent effect in 28 cases and good effect in the other 3. Post-operative small pneumothorax and subcutaneous emphysema occurred in 4 eases, which disappeared on chest ray examination 1 month later without special treatment. Surgical wound infection was found in 1 case 4 months post-operatively, but healed after dressing treatment. Displacement of the internal fixation occurred in one patient half a year later, who underwent a second opera- tion through bilateral fixation with a steel gasket, which remained in place during the 1.5-year follow-up. The bars were removed with- out serious complications in 28 patients, their postoperative hospital stay ranging from 2 to 3 days, with excellent effect in 24 cases, good effect in 4, and recurrence in none. Conclusion Modified Nuss procedure without thoracoscopic assistance is effective and minimally invasive for the correction of peetus excavatum. The short- and mid-term effect of the procedure is desirable, while its long- term effect is to be observed by further follow-up studies.
出处
《医学研究生学报》
CAS
北大核心
2013年第3期277-279,共3页
Journal of Medical Postgraduates
